Organisational Booking Form Breck Foundation

Breck Foundation Booking Form

Please complete all sections and make sure to review all information. If you have any questions after completing it please email admin@breckfoundation.org
Your Name*

First NameLast Name
Name of your organisation*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Address

Address Line 2 (Optional)

Town/ CityCounty

Post Code
Please select the date you would like your presentations to take place:*

DayMonthYear
Date
Please select an alternative date that would work for you if your first choice is unavailable:

DayMonthYear
Date
Please let us know what time you would like your presentations to start
Would you like your session(s) delivered online or face-to-face?*

OnlineFace-to-face
What type of organisation would you like to book sessions for? (This helps direct you to the correct booking form)*

Youth GroupUniversity/Teacher TrainingConferenceFostering OrganisationSocial WorkersBusiness or Corporate OrganisationOther

University/Teacher Training Booking Form

We value the oppourtunity to work with students and student teachers before they are in the field, making sure that internet safety and grooming awareness is embedded in professional practice from the word go.
What course and year would you like a presentation for?*
Do you have any specfic topics or themes that you would like us to cover?*
Our pricing for university sessions can be found here: University/Teacher Training Pricing Please review this information and tick below to confirm acceptance.
I have reviewed the pricing information*

Conference Booking form

We present at conferences across the UK to spread the message of Breck's story and shed light on the topric of internet safety. We are leading the way in creatinga safer internet for children and young people.
Please tell us a little about your theme:*
Please enter the address of the place the conference is taking place at:*
Our pricing for Conference sessions can be found here - Conference Pricing (to open this in a seperate window hold Ctrl+left click)

Please review this information and tick below to confirm acceptance.
I have reviewed the pricing information.*

Fostering Organisation Booking Form

We believe a 'whole picture’ approach is crucial for children’s safety and well-being therefore we strive to reach every child, foster parent, social worker and care worker.
What is the age range of the young people we are presenting too?
Approximately how many young people will be attending the presentaion(s)?
Do you have any specific topics you would like us to mention?
Do any of the young people taking part have any special educational needs we should be aware of so we can adjust our presentation accordingly?
Would you like a parent/ carer presentation in addition to your youth group presentation(s)? Please note: These presentations take place exclusivly online, usually after 6pm and preferably the day before your session(s)

YesNo
Our pricing for sessions can be found here - Fostering Organisations Pricing (to open this in a seperate window hold Ctrl+left click)

Please review this information and tick below to confirm acceptance.
I have reviewed the pricing information.*

Social Worker Organisation Booking Form

We believe a 'whole picture’ approach is crucial for children’s safety and well-being therefore we strive to reach every child, foster parent, social worker and care worker.
Name of Social Worker Organisation?*
Approximately how many young people will be attending the presentation(s)?
Do you have any specific topics or themes that you would like us to cover?*
Our pricing for sessions can be found here - Social Worker Organisation Pricing (to open this in a seperate window hold Ctrl+left click)

Please review this information and tick below to confirm acceptance.
I have reviewed the pricing information.*

Business or Corporate Organisation Booking Form

We take a whole community approach, working with parents, private sector employees and the wider UK public to create a network of digital champions. All of the adults we empower to take effective action to protect the wellbeing and lives of young people help keep young people safe on the internet.
Approximately how many attendees will there be?*
Do you have any specfic themes or topics you would like us to cover?
Our pricing for Corporate sessions can be found here - Corporate Pricing (to open this in a seperate window hold Ctrl+left click)

Please review this information and tick below to confirm acceptance.
I have reviewed the pricing information*
Would you like more information about becoming a Corporate Breck Foundation Friend? Our BFF's are our partner organsations and individuals that support our work long term.*

YesNo

Other - Request form.
Please use this space to describe what type of event you are looking to book one of our speakers for, including the date, time, duration and location you would need us to attend. PLEASE NOTE: There may be a cost to our services, we will check over your request and get back to you ASAP.*

Travel Information

Please include any information our speakers may need to get to you.
Are there any specfic requirements or directions to your location that our speaker may need?
Will there be a parking space avaialble to our speaker on the day?
What is the name of your nearest train station?

Help us grow as an organisation
How did you hear about our talks?
Would you be interested in hearing about group fundraising activities that you and your colleagues can take part in? (e.g., the London Landmarks Half Marathon or the Big Breck Walk)

YesNo
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Breck Foundation Booking Form